Australia: Infectious diseases experts - stay away from bats

Infectious diseases experts at a major
international infectious diseases conference have issued a
stark warning for people to stay away from bats, after
releasing details of the treatment of an 8-year-old boy in
Queensland, Australia, who died from Australian Bat
Lyssavirus (ABLV) earlier this year. Dr Joshua Francis and
Dr Clare Nourse (Paediatric Infection Management Service,
Mater Children’s Hospital, Brisbane, QLD) and colleagues
issued the warning at the Australasian Society for
Infectious Diseases (ASID) meeting taking place this week in
Canberra, Australia.

ABLV was first identified in
Australian bats and flying foxes in 1996 and remains common
in both animals, though human infection is extremely tare.
Two adult cases were confirmed in 1996 and 1998, and
followed a similar disease course to rabies before being
fatal in both cases. One was a woman bitten by a flying fox
after trying to remove it from a child, the other a carer
who looked after these animals. Other lyssavirus strains
circulate in bats in the USA and Europe, and multiple cases
of human infection, and subsequent deaths, have been
reported. Thus this warning issued by experts applies to
wherever bat or flying fox populations exist.

There is no
proven effective treatment for lyssavirus infection in
humans. Only experimental treatments have been applied, such
as the antiviral amantadine and other measures such as
maintaining sedation and glucose balance, which have not
been shown to be effective. Once the disease has progressed,
it is almost always fatal.

The 8-year-old boy is just the
third reported case of ABLV and the first in a child. At the
ASID meeting, Dr Francis described what happened to the
8-year-old boy, who was bitten during a family holiday to
northern Queensland in December 2012. The boy did not tell
his parents he had been bitten, and three weeks later began
to suffer convulsions, severe abdominal pain and fever,
followed by progressive brain problems, with intermittent
periods of lucidity. The boy was intubated and ventilated
while doctors frantically tried to establish what was wrong
with him. Analysis of his brain and spinal fluid were normal
at first, but on day 10 of his admission increased levels of
lyssavirus were detected. The boy’s neurological condition
deteriorated, characterised by symptoms such as abnormal
movements, and he then went into a coma. Treatment with
amantadine was unsuccessful, and he tragically died on
February 22, 2013.

Dr Francis says the warning has been
issued not just for the danger from bats themselves, but the
risk, however remote, that the disease can spread between
humans. He says: “Human to human transmission of
lyssaviruses had not been well documented, but it is
theoretically possible. Local and international guidelines
recommend post-exposure prophylaxis (PEP) for anyone who has
had skin or muscosal contact with saliva or neural tissue
from an infected person. This involves immunoglobulin
treatment and vaccination. Following the diagnosis, we
identified 175 potential contacts of the boy, and of these
five household members and 15 healthcare-workers were
offered PEP.”

He concludes: “ABLV has proved fatal in
all cases reported to date. There is a need for increased
public awareness of the risk associated with bat contact. In
short, people should stay away from bats. For anyone
exposed, PEP is effective at preventing progression to
disease, and should be considered as soon as possible in all
cases that constitute a potentially significant
exposure.”

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